ISWM_Past_Performance_Questionnaire.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Offeror’s Name: ______________________________________________________________

Address: ___________________________________________________________________

Point of Contact: _____________________________________________________________

Project Title and Brief Description of Work: _____________________________________*

Contract Number: __________________________________________________________*

Dollar Amount: ____________________________________________________________*

Contract Period or Dates of Performance: _______________________________________*

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your company in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: ___________________________________________________________

Title: ________________________________________________________________________

Address: _____________________________________________________________________

Email Address: ______________________________________________________________

Telephone Number: ______________________________

Fax Number: ________________________________

C. E-MAIL COMPLETED SURVEY FORM TO: judith.jennings@us.af.mil. If e-mail is not a source of delivery, please contact Ms. Judith Jennings at (618) 256-9271 or Ms. Marcia

Wuebbels at (618) 256-9308.

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, V, S, M, U, and N/A) that most accurately describes the contractor’s performance or situation.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E V S M U N/A

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

Performance meets contractual requirements and exceeds many requirements to the

Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements and exceeds some requirements to the

Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Performance does not meet some contractual requirements.

The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Unable to provide a rating.

Contract did not include performance for this aspect, performance was not observed, or information was not available.

Do not know.

CONTRACTOR’S NAME: ______________________________________________________

CONTRACT NUMBER: ________________________________________________________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

mailto:judith.jennings@us.af.mil

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E V S M U N/A

1. Provided experienced managers, supervisors, and technicians with the technical and administrative abilities needed to meet contract requirements.

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel.

3. Followed and satisfied contractual/project requirements.

4. Adhered to all local, state, federal regulations and Final Governing

Standards (FGS).

5. Corrected deficiencies and/or satisfied service requirements in a timely manner pursuant to contractual/project requirements.

6. Responsive to contract change(s).

7. Receptive to contract change(s).

8. Submitted invoices/billing in a timely manner with minimum delay.

9. Promoted good working relationships.

10. Maintained equipment in good workable condition, trucks and containers washed and free odors.

11. How would you rate the contractor's overall performance?

12. Was the contractor ever issued a citation or notice of violation under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

13. Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

CONTRACTOR’S NAME: ____________________________________________________

CONTRACT NUMBER: ______________________________________________________

Remarks: